Thesis (M.P.H.)--University of Michigan, 1947.

Thesis (M.P.H.)--University of Michigan, 1947.

A dissertation submitted to the School of Public Health, University of the Witwatersrand, in fulfillment of the requirements for the degree of Master of Science in Medicine by research and dissertation. 07 June 2016 / Introduction: Migrant farm workers in South Africa are particularly vulnerable to HIV infection for a multitude of reasons, including a lack of access to health services and to health information. Social norms on the farms, including an acceptance of multiple concurrent sexual partners and transactional sex both for comfort and material gain, tend to worsen women's powerlessness to manage effectively their sexual reproductive health. High levels of stigma also mean that the risks of HIV infection cannot easily be spoken about, further increasing vulnerability. The Hlokomela project sought to use participatory communication processes to empower peer communicators on the farms to engage farm workers in regular, structured discussions on HIV /AIDS and other health and wellness related matters, including difficult conversations around gender inequity. The making of a collective identity for the project was one of these participatory processes. Its novelty in this setting warranted research to answer the question "How does (or does) the collective making of a project identity help to promote health on the farms of Hoedspruit?". Aim: The aim of the research was to describe and analyse the role of collective identitymaking in the Hlokomela project, an intervention to address vulnerability to HIV among migrant and seasonal farm workers in Hoedspruit, Limpopo province, South Africa. The study aimed also to propose and further develop, in the light of Findings, a conceptual framework which would help to explain the effects of the various elements of collective identity-making. Methods: The research is a qualitative study of the collective identity-making component of the Hlokomela health project. Elements of a grounded theory approach were adopted in the three successive data collection site visits, enabling progressive coding of the data as the collection occurred. Data was collected through two Focus Group Discussions (FGD) with Nompilos (farm worker volunteer peer communicators and care givers) and two FGDs with Gingirikani (farm worker volunteer peer communicators chosen by Nompilos and farm workers to be their deputies on the farms, to facilitate purposive dialogues and thus increase reach). There were also 10 individual in-depth interviews with other key stakeholders and three small group interviews (2-3 respondents) with Hlokomela managers and co-ordinators. All interviews were audio-taped, transcribed and where necessary translated into English from Xitsonga and Sepedi. The voices of those most directly affected by the intervention formed the basis for coding and analysis. Findings: The development of the collective identity through participatory processes was found to enhance engagement with and among farm workers. This was due to the project's perceived pertinence and local ownership. The collective identity was seen to be relevant and expressing a farm worker reality. Farm workers generally described feeling affirmed, seeing themselves projected into a public space that had hitherto not been open to them. And also in particular, the agents of the project – the Nompilos and their "deputies" the Gingirikani – described at length how being associated with Hlokomela gave them the authority and credentials to work with farm workers on sensitive matters, including establishing a set of values and norms which would be health-protective but which also involved a shift in what was considered possible and desirable. There was furthermore a sense of belonging to the project, not only on the part of the primary "beneficiaries" – farm workers – but also of other stakeholders, including farm owners/managers, municipal office bearers, and local health workers. This bridging social capital further augmented the project's capacity to reach farm workers by, for example, enabling access in working time on the farms, by donations in money and in kind by the local community, and by making visible and normal what hitherto had been hidden – particularly in terms of gender equity and a softening of hegemonic masculinities. Farm workers could take the lead, and women could take the lead also. Conclusions: The collective identity-making work of Hlokomela had aided the project's agents to nurture a new possible, founded in a slightly altered set of values and norms, which had the potential to reduce vulnerability to HIV infection. The elaboration of a social institution, largely in the symbolic space, had authorised the project's agents, in their own eyes as well as those of their peers, to carry out their often difficult work of facilitating regular dialogues on hitherto rarely broached topics, including gender relations and risky sexual behaviour. The findings indicate a need for further research into the cost effectiveness and replicability of this kind of identity work in similar projects, perhaps with the addition of quantitative assessments of the extent of projects' reach through collective identity work as well as the value of collateral beneficial effects to participants in resource poor settings. / MT2016

Thesis (M.A. (Health Social Scinece))--Mahidol University, 2006. / LICL has E-Thesis 0012 ; please contact computer services.

Thesis (doctoral)--Lund University, Sweden, 1994. / Includes bibliographical references.

A acelerada transição demográfica ocorrida nas quatro últimas décadas trouxe implicações para os arranjos familiares, as relações de trabalho, o emprego e a renda, além do comum fenômeno da migração, sendo que as complexas relações entre essas dimensões acarretam importantes desafios para o cuidado em saúde dos idosos. No contexto da migração no país, os idosos em condições socioeconômicas desfavoráveis têm migrado por contingências, sobretudo, relativas à saúde e moradia e, na maioria desses casos, o apoio necessário obtido em relação à saúde baseia-se, fundamentalmente, na Atenção Primária à Saúde, sob a Estratégia de Saúde da Família. Assim, o objetivo deste trabalho é compreender as necessidades e o cuidado em saúde de idosos residentes no Município de São Paulo e migrantes do Nordeste, bem como os limites e potencialidades dos serviços de Atenção Primária no tocante a essa problemática. Busca-se, ainda, (re)considerar a relação entre usuários idosos e integrantes de equipes de Saúde da Família no Município de São Paulo, ao compreender a forma como as marcas identitárias são caracterizadas e em que medida podem influenciar a relação entre esses sujeitos, no que se refere ao tratamento de saúde. Trata-se de uma pesquisa de referencial qualitativo, que utilizou a técnica de entrevista em profundidade na produção dos dados empíricos, que consistiu em duas etapas: entrevistas realizadas com 06 idosos, com 60 anos ou mais, que se deslocaram para o Município de São Paulo, em um intervalo de 03 meses a 05 anos, com o propósito de tratar seu(s) problema(s) de saúde; e entrevistas com 09 profissionais de equipes da Estratégia de Saúde da Família. Referente à análise dos depoimentos, utilizou-se a técnica de análise temática de conteúdo, considerando as conjunturas, as razões e as lógicas de falas, bem como as ações e inter-relações estabelecidas com o coletivo e as instituições. Os resultados exibem a complexidade dos sentidos atribuídos às necessidades de saúde dessa população em específico, sendo que, de forma convergente, ambos os grupos entrevistados destacaram o entrelaçamento das necessidades de saúde e do adoecimento. Além disso, os constructos socioculturais regionalizados mostram-se imperativos, uma vez que o processo de significação, diante da necessidade em saúde, assume contornos firmados em experiências anteriores de saúde-doença-cuidado. Já a autopercepção de saúde, a definição de problema e as estratégias e recursos para o cuidado em saúde foram proporcionalmente relativos ao contexto (pessoal, social e econômico) no qual esses idosos estavam inseridos antes de residirem na metrópole paulistana. Segundo os profissionais, a carência de recursos, a falta de conscientização e a dificuldade de acesso aos serviços de saúde em suas localidades de origem resultam, muitas vezes, em um agregado de diagnósticos realizados em São Paulo. Por sua vez, para os idosos, a produção de cuidados está muito mais associada às práticas curativas, sendo pouca a valorização de medidas preventivas e promocionais de saúde. Nesse sentido, de acordo com os profissionais, à medida que não apresentam sinais ou sintomas, eles tendem a cessar o tratamento médico e farmacológico. / The accelerated demographic transition happened in the last four decades brought implications for the family arrangements, the work relationships, the job and the income, besides the common phenomenon of the migration, and the complex relationships among those dimensions cart important challenges for the health care of the aged. In the context of the migration in the country, the aged in unfavorable socioeconomic conditions have been migrating for contingencies relative to, above all, the health and home and, in most of those cases, the necessary support obtained in relation to the health is based, fundamentally, in the Primary Health Care, through the Family Health Strategy. So, the objective of this paper is to understand the needs and health care of aged resident in the Municipal district of São Paulo and transients and migrants of the Northeast, as well as the limits and potentialities of the services of Primary Health Care concerning that problem. Also, it is looked for (re)considering the relationship between the aged users and the teams members of Family Health in the Municipal district of São Paulo, when understanding the form as the identity marks are characterized and in that measured they can influence the relationship among those subjects, in what it refers to the health treatment. This is a qualitative research, that used the in-depth interview technique for the production of the empiric data, that consisted of two stages: interviews with 06 aged, with 60 years old or more, who moved for the Municipal district of São Paulo in an interval of 03 months to 05 years, with the purpose of treating their health problems; and interviews with 09 professionals of teams of the Family Health Strategy. Regarding the analysis of the depositions, the thematic analysis of content technique was used, considering the conjunctures, the reasons and the logics of speeches, as well as the actions and established interrelations with the collective and the institutions. The results exhibit the complexity of the senses attributed to the health needs of that population in specific, and, in a convergent way, both groups detached the interlacement of the health needs and the sickness. Besides, the regional sociocultural thoughts are shown imperatives, once the significance process, before the health need, assumes outlines in previous experiences of health-disease-care. The self-perception of health, the problem definition and the strategies and resources for health care were proportionally relative to the context (personal, social and economical) in which those aged ones were inserted before they live in the metropolis of São Paulo. According to the professionals, the lack of resources, the understanding lack and the access difficulty to the health services in their origin places result, a lot of times, in an attaché of diagnoses accomplished in São Paulo. For the aged, the production of cares is much more associated to the healing practices and it is little the valorization of preventive and promotion measures of health. In that sense, in agreement with the professionals, as they dont present signs or symptoms, they tend to interrupt the medical and pharmacological treatment.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0038 ; please contact computer services.

A acelerada transição demográfica ocorrida nas quatro últimas décadas trouxe implicações para os arranjos familiares, as relações de trabalho, o emprego e a renda, além do comum fenômeno da migração, sendo que as complexas relações entre essas dimensões acarretam importantes desafios para o cuidado em saúde dos idosos. No contexto da migração no país, os idosos em condições socioeconômicas desfavoráveis têm migrado por contingências, sobretudo, relativas à saúde e moradia e, na maioria desses casos, o apoio necessário obtido em relação à saúde baseia-se, fundamentalmente, na Atenção Primária à Saúde, sob a Estratégia de Saúde da Família. Assim, o objetivo deste trabalho é compreender as necessidades e o cuidado em saúde de idosos residentes no Município de São Paulo e migrantes do Nordeste, bem como os limites e potencialidades dos serviços de Atenção Primária no tocante a essa problemática. Busca-se, ainda, (re)considerar a relação entre usuários idosos e integrantes de equipes de Saúde da Família no Município de São Paulo, ao compreender a forma como as marcas identitárias são caracterizadas e em que medida podem influenciar a relação entre esses sujeitos, no que se refere ao tratamento de saúde. Trata-se de uma pesquisa de referencial qualitativo, que utilizou a técnica de entrevista em profundidade na produção dos dados empíricos, que consistiu em duas etapas: entrevistas realizadas com 06 idosos, com 60 anos ou mais, que se deslocaram para o Município de São Paulo, em um intervalo de 03 meses a 05 anos, com o propósito de tratar seu(s) problema(s) de saúde; e entrevistas com 09 profissionais de equipes da Estratégia de Saúde da Família. Referente à análise dos depoimentos, utilizou-se a técnica de análise temática de conteúdo, considerando as conjunturas, as razões e as lógicas de falas, bem como as ações e inter-relações estabelecidas com o coletivo e as instituições. Os resultados exibem a complexidade dos sentidos atribuídos às necessidades de saúde dessa população em específico, sendo que, de forma convergente, ambos os grupos entrevistados destacaram o entrelaçamento das necessidades de saúde e do adoecimento. Além disso, os constructos socioculturais regionalizados mostram-se imperativos, uma vez que o processo de significação, diante da necessidade em saúde, assume contornos firmados em experiências anteriores de saúde-doença-cuidado. Já a autopercepção de saúde, a definição de problema e as estratégias e recursos para o cuidado em saúde foram proporcionalmente relativos ao contexto (pessoal, social e econômico) no qual esses idosos estavam inseridos antes de residirem na metrópole paulistana. Segundo os profissionais, a carência de recursos, a falta de conscientização e a dificuldade de acesso aos serviços de saúde em suas localidades de origem resultam, muitas vezes, em um agregado de diagnósticos realizados em São Paulo. Por sua vez, para os idosos, a produção de cuidados está muito mais associada às práticas curativas, sendo pouca a valorização de medidas preventivas e promocionais de saúde. Nesse sentido, de acordo com os profissionais, à medida que não apresentam sinais ou sintomas, eles tendem a cessar o tratamento médico e farmacológico. / The accelerated demographic transition happened in the last four decades brought implications for the family arrangements, the work relationships, the job and the income, besides the common phenomenon of the migration, and the complex relationships among those dimensions cart important challenges for the health care of the aged. In the context of the migration in the country, the aged in unfavorable socioeconomic conditions have been migrating for contingencies relative to, above all, the health and home and, in most of those cases, the necessary support obtained in relation to the health is based, fundamentally, in the Primary Health Care, through the Family Health Strategy. So, the objective of this paper is to understand the needs and health care of aged resident in the Municipal district of São Paulo and transients and migrants of the Northeast, as well as the limits and potentialities of the services of Primary Health Care concerning that problem. Also, it is looked for (re)considering the relationship between the aged users and the teams members of Family Health in the Municipal district of São Paulo, when understanding the form as the identity marks are characterized and in that measured they can influence the relationship among those subjects, in what it refers to the health treatment. This is a qualitative research, that used the in-depth interview technique for the production of the empiric data, that consisted of two stages: interviews with 06 aged, with 60 years old or more, who moved for the Municipal district of São Paulo in an interval of 03 months to 05 years, with the purpose of treating their health problems; and interviews with 09 professionals of teams of the Family Health Strategy. Regarding the analysis of the depositions, the thematic analysis of content technique was used, considering the conjunctures, the reasons and the logics of speeches, as well as the actions and established interrelations with the collective and the institutions. The results exhibit the complexity of the senses attributed to the health needs of that population in specific, and, in a convergent way, both groups detached the interlacement of the health needs and the sickness. Besides, the regional sociocultural thoughts are shown imperatives, once the significance process, before the health need, assumes outlines in previous experiences of health-disease-care. The self-perception of health, the problem definition and the strategies and resources for health care were proportionally relative to the context (personal, social and economical) in which those aged ones were inserted before they live in the metropolis of São Paulo. According to the professionals, the lack of resources, the understanding lack and the access difficulty to the health services in their origin places result, a lot of times, in an attaché of diagnoses accomplished in São Paulo. For the aged, the production of cares is much more associated to the healing practices and it is little the valorization of preventive and promotion measures of health. In that sense, in agreement with the professionals, as they dont present signs or symptoms, they tend to interrupt the medical and pharmacological treatment.

A study was conducted to investigate and compare the nutritional status and physical work performance of children of Brazilian migrant agricultural workers with Brazilian children from wel1-to-do backgrounds. The relationship between nutritional status and physical work performance was also investigated. Dietary analysis was conducted using the 24-hour diet recall method. Evidence was found that intakes of energy, calcium, thiamin, riboflavin, niacin, and vitamin C may have been inadequate among migrant worker children. Their diet was generally monotonous and consisted mainly of rice, beans, and coffee with sugar. Diets of well-to-do children were considerably more varied with good representation from all major food groups. Anthropometric assessment indicated that migrant worker children had values for weight and triceps skinfold thickness that were low compared to American standards. Values for height, arm circumference, and arm muscle circumference were average compared to American standards. Well-to-do children exceeded American standards for all anthropometric parameters measured. Biochemical investigations of protein and iron status were also conducted. Serum total protein and albumin levels were normal in most subjects in both groups. However, many migrant worker, children had low values for hematocrit, serum iron, and transferrin saturation. Most well-to-do children had normal values for these parameters. Hemoglobin levels were adequate in most subjects. Physical work performance was found to be impaired in migrant worker children. Exercise heart rates and post-exercise blood lactic acid levels in response to a standardized bicycle-ergometer work test were significantly higher in migrant worker compared to wel1-to-do children. In addition, a significant correlation was found between anthropometric indicators of nutritional status and parameters of physical work performance. Finally, socio-economic and ecological assessment indicated that the living conditions of migrant worker children were impoverished and unsanitary. This probably aggravated health problems such as infections that were found to occur among these children. Well-to-do children did not share these conditions. / Land and Food Systems, Faculty of / Graduate

With the urbanization phenomenon, a population of unskilled migrant workers commonly known as Boia- Frias has rapidly grown up in slums on the peripheries of Brazilian cities. This study was carried put to assess the food habits and nutritional status of 100 Boia-Fria families of Vila Recreio, a slum area on the edge of Ribeirao Preto, S.P., Brazil, using dietary, anthropometric, and biochemical investigations. Qualitatively, the Boia-Fria diet was monotonous and simple, consisting basically of polished rice, beans, white bread, and coffee with sugar. In general, the foods which were lacking were: milk products, meats, fish, eggs, poultry, non-refined grain products, and fruits and vegetables rich in vitamins A and C. Foods of low nutritional value such as starchy gruels, sugar-water, herb tea, coffee with sugar and soft drinks were commonly used as weaning foods. Although dietary practices of pregnant and lactating women were poor, breastfeeding was still practiced by most mothers. According to 24-hour dietary recall data, conditions existed which were conducive to the development of nutritional problems, especially with respect to calcium, vitamin A, riboflavin, niacin, vitamin C, and iron, of the nutrients tested and with respect to quantitative intake of food. Biochemical data confirmed the presence of early malnutrition, pre-clinical in nature for about 257o of the population with respect to vitamin A, carotene, and iron. Plasma cholesterol, total lipid and vitamin E values were found to be normal. Anthropometric examinations revealed clear signs of clinical undernutrition among men and women as well as some degree of obesity among women. Child mortality data provided evidence of some advanced clinical malnutrition among children. Basic causes of malnutrition among the Boia-Frias included the following ecological factors: recent urbanization; housing, sanitation, and environmental conditions, associated with serious infection problems; poverty; illiteracy; and an ignorance of what constitutes good nutrition. Recommendations for intervention and "long-range" nutrition programs to minimize the harsh effects of poverty and upheaval on these migrant workers of Brazil were suggested. / Land and Food Systems, Faculty of / Graduate